Optimising patient weight management prior to arthroplasty: A feasibility study

Dr Furkan Genel1,7, Ms Natalie Pavlovic1,7, Monique Boulos5, Danella Hackett5, Manxin Gao1, Karen Lau5, Prof Sarah Dennis2, A/Prof Kathy Gibson1, Prof Nick Shackel1, Leanne Gray5, Dr Geraldine Hassett1, Adriane Lewin1, Dr Kathryn Mills, Shaniya Ogul5, Susan Deitsch5, Carol Vleeskens5, Dr Bernadette Brady3, Dr Rob Boland2, Prof Ian Harris1,7, Prof Vicki Flood2, Dr Milan Piya6, A/Prof Sam Adie1, A/Prof Justine Naylor1,7

1Faculty of Medicine, University Of New South Wales, Kensington, Australia, 2Faculty of Medicine and Health, University of Sydney, 3School of Science and Health, Western Sydney University, 4Faculty of Medicine and Health Sciences, Macquarie University, 5Fairfield Hospital, South Western Sydney Local Health District, 6Faculty of Medicine, Western Sydney University, 7Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research

Background: Obesity is associated with worse outcomes following total hip or knee arthroplasty (TKA/THA) and increased episode-of-care costs. It is unclear whether people with obesity awaiting surgery can lose a significant amount of weight pre-surgery in order to improve outcomes.

Objective: To determine the feasibility of a dietitian-led low-inflammatory weight-loss program for people with obesity awaiting arthroplasty.

Methods: A quasi-experimental pilot study enrolled people with obesity (BMI ≥ 30) and waitlisted for primary TKA/THA into ‘usual care’ (UC) or a weight-loss (low-inflammatory diet) program (Diet). Assessments at baseline and pre-surgery (~11 months later) included anthropometric measurements, patient-reported outcomes and dietary profile indicating compliance with a low inflammatory diet (MEDICUL). The mean between-group difference (MD) and 95%CI are reported.

Results: 97 people consented to the study (UC n=47, mean age 67 years, mean BMI 37; Diet, n=50, mean age 66 years, mean BMI 36). At pre-surgery assessment, the Diet group reported greater adherence to a low-inflammatory diet (MD 9 points (95%CI +3 to +16)) and tended to have more favourable between-group differences in weight loss (MD -0.7kg (-4 to +2)), timed up-and-go (MD -3sec (-9 to +3)) and waist circumference (MD -2cm (-10 to +6)). UC had more favourable changes in Oxford Knee Score (MD -1.5 (-6 to +3)) and Oxford Hip Score (MD -3.8 (-12 to +4)) compared to the Diet Group. Four people in Diet Group were waitlist removed by choice.

Conclusion: Pilot data suggest our program may promote weight loss but the clinical effects for most are modest.


Dr Furkan Genel (B Med Sci (Hons), MD) is currently completing his PhD at UNSW. He worked as an Orthopaedic Registrar in Christchurch Hospital, New Zealand. Furkan’s research focuses on addressing issues affecting complications after knee or hip arthroplasty.

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